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Can someone tall me if salt baths are indicated or if they are contraindicated for venous ulcers.

I did not know that salt baths are indicated for anything these days!.

We were always told to advise patients to use them post nail surgery.

Hi peter,

I currently work in a high risk/Wound foot clinic. I would not recommend Salt baths for anything especially venous wounds. The potential for infection and maceration of the wound base and surrounding skin is high.

Gold standard treatment options are mainly compression and controlling exudate levels with absorbent dressings if needed. I would recommend anyone with a wound to keep it dry for these reasons.

Hope it helps. Can look for some literature if you’re keen.

Cheers Justin

Thanks for your reply Justin, i have met a patient with a venous ulcer on the front of the tibia about 4 inches above the malleolar, it was originally diagnosed as a basil cell carcinoma and surgically excised. He is currently compressing the limb below the knee which seems to be reducing the exudate. He has a dysfunctional gait which i believe is the cause of his venous insufficiency, ( has anyone seen this before ) because of this its going to be hard to keep the exudate levels down so the wound can heal, do you have any suggestions, also i am sure it varies from patient to patient but how do you decide how much compression is best.

Hi Peter 96,

venous leg ulcers are present because the venous system is compromised and unable to push the fluid back up the leg due to complications with the valves in the deep / superficial veins and or the perforators, the exudate you see coming out the leg is some of the excess that has build up in the limb and tissue as the veins have become distended.

Venous Ulcers used to be washed using Saline solution but the Cochrane report advises that normal tap water is sufficient for this (UK). There are also concerns about using saline pods as when compressed to expell the saline the pressue directed at the wound may push bacteria further into the wound.

At NO time should any patient be placed in comperssion stockings or multi layer bandages without a full Doppler or pulsicsymetry being completed.

Because of the levels of compression required 40mm Mercury at the ankle lowering to 20mm Mercury at the knee its very dangerous/ negligent to apply compression without first checking the limbs blood supply.

If you apply compression to a leg with and ABPI of for example <0.6 you run the risk of occluding the limb. Also in a limb with a ABPI of above 1.3 you need to consider calcification and the adverse consequences of compressing such limbs. Between the figures of 0.6 and 1.3 there are different levels of compression to be recommended and further more different systems depending on patient mobility.

Compression bandaing is as mentioned the Gold Standard treatment for venous leg ulcers but incorrect diagnosis and treatment can be very dangerous. My advice is refer the patient to their Doctor or local practice nurse for full assessment. In the UK certainly there are nurses trained in the application and measuring of limbs for compression bandaging. I am not aware of the general practice of Podiatrists in Australia or what your Society covers you for but I'd strongly recommend you do not apply compression and refer on.

Could you advise what you see in the gait that you believe to be related to the venous insuficiency?

I completely agree with amcclean!

The amount of compression suitable (if any at all) is dependent on the vascular supply of the limb. In Australia I would also recommend referring for full doppler studies and assessment by a vascular specialist. From there in the public health system some physio's can measure up as will OT's.

Best to referr back to the GP if your not sure of anyone who does this in your area!

Justin

HI Peter96,

I just re-read your thread regarding the cause of venous insuficiency being gait related.

As mentioned venous insuficiency is related to the incompetance of the valves and their subsequent inability to aid in the movement of venous blood back up the leg.

If a pateint is inactive, eg wheelchair/bed bound, then the fluid may gather more in the limb as the gastroc/soleus pump etc is not being utilised to compress the veins and push the fluid upwards. it is the contraction of the gastroc/soleus pump that compresses the veins and pushes the fuild up with the valves opening and closing in a lock gate fashoin to aid trhe one way movement of the fluid.

How mobile is your pt? If they can walk around and the gastroc/soleus pump is working then I would question if the gait is related.

As earlier menionted there are different types of compresion avalaible for active and in-active pt's each of which work in a different way to provide the compression on the veins to move the fluid.

Is your pt mobile or immobile?